Overview

Using a comprehensive initial assessment of the revenue cycle, re|solution identifies areas where the facility has not received the reimbursement for which it is entitled. The assessment looks at all phases of the revenue cycle including: scheduling, registration, charge capture, coding, billing, collections, reimbursement, interviewing key personnel, reviewing and analyzing trended data, key processes and actual claims. The analysis of revenue cycle data, processes and procedures is then compared to peer group and best practices. The assessment report identifies specific opportunities that will generate additional cash.

Once the initial assessment is completed, a presentation is made to hospital management and partnering together, an action plan is developed to insure the facility is paid the correct amount for services performed.

Challenge

Today, rural and community hospitals face enormous challenges. The same charge capture, coding and reimbursement issues that plague larger facilities also affect rural and community hospitals with fewer resources to ensure compliance and appropriate reimbursement for services provided. re|solution’sre|assess provides a safety net to ensure that the provider receives all the monies they are due.

Solution

Combining the results of our on-site analysis, interviews, and a proven action plan process, re|assess allows personnel at the departmental level to work with the revenue cycle personnel in optimizing reimbursement. This is the key to an effective revenue cycle; getting the clinicians and the business people working together. The process also allows the facility to explore other opportunities for improvement such as point of service collections, denial management, self-pay management, contract payment review, and EHR implementation for meaningful use. re|assess gives our clients the peace of mind that all services are being reimbursed at an appropriate level.

Results

A comprehensive revenue cycle improvement plan is a necessary part of a best practice revenue cycle. Hospital management and re|solution agree upon the net benefit opportunities and partner to optimize net reimbursement, denials and appeals opportunities, and expense reductions along with various other opportunities as the provider moves toward a best practice revenue cycle.